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There has been a spectacular fall in child mortality in developed countries in recent decades. According to a report from UNICEF, the decline in under-five mortality from 1990 to 2012 has been 57% in developed regions compared with 47% in developing regions.1

In England and Wales in 1974, 16 900 children died; in 2012, the figure was 4900.2 Thus, if intervening demographic changes are overlooked, it could be claimed that social and medical progress has kept alive each year 12 000 children who would have died four decades ago. However, the improving trend has not been evenly distributed among nations, regions, and age and demographic groups.

The Lancet has published an important series of papers that should both worry and motivate everyone who works in child health, especially those of us in the UK. These papers underpin the report published by the UK Royal College of Paediatrics and Child Health in May 2014, ‘Why children die’, which stimulated significant media interest.3

Viner, Wolfe and colleagues compared trends in overall mortality between the UK and a group of 17 countries that are socio-economically comparable (the ‘EU15+’, 15 European countries plus Canada and Australia but …

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